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The right thing to do



In the autumn of 2011, shortly after taking part in a one day strike in protest at the proposed changes to NHS pensions and the wider destruction of the NHS proposed in the Health and Social Care legislation which was then passing through parliament, I was chatting about the NHS, over a beer, with the finance director of a central London hospital. Whilst she admired the strikers for standing up for what they believed in, her view was that there was “no alternative” for the NHS other than to face up to the bleak financial reality of years of “efficiency savings” following the financial crisis of 2008. It was a view that was widespread at the time, and still is, amongst senior NHS figures. A view that says that we must pay for the global financial crisis by slimming down public services like the NHS; it’s considered the “the right thing to do” in the circumstances.

Meanwhile, across town, protesters from the Occupy movement were camped out in front of St Paul’s Cathedral and the City of London, for once, felt like a vibrant place to be, alive with discussion and bubbling with new ideas and the hopes that a better society could be salvaged from the wreckage of a failed capitalist system. In cities and towns around the country there were similar tented protests. So it felt doubly dispiriting that, in contrast, the person in charge of the purse strings at a high profile London hospital should adopt such a narrow minded view of the crisis faced not only by the NHS but all public services.

The slimming down of the NHS during the last half dozen years has almost inevitably meant that the quality of care that patients receive has suffered. It’s apparent in the longer waiting times for routine operations and in the struggles of Accident and Emergency departments to cope. It’s apparent too in the increase in the numbers of patients who are forced to stay longer in hospital than they should because huge cuts to funding for social care often mean that there is nowhere for them to go. A recent audit at Plymouth Hospital found that 27% of beds were taken up by people who were medically fit to leave. And it’s apparent too in the lack of time patients are able to spend with their GPs, in the rationing of healthcare such that certain procedures are only available to those who are in the most pain and in mental health services across the country that are stretched to breaking point. And still we are told by a whole host of senior NHS figures representing NHS England, provider Trusts and Clinical Commissioning Groups that there is no alternative.

This situation is the culmination of more than two decades work by both Conservative and Labour governments. The Tories began the process in the early nineties with the break up of the NHS into purchasers and providers of healthcare; a system referred to as the “internal market” and the first step to encouraging greater private sector involvement in the NHS. The NHS, as an example of socialism in action with everyone arriving through the doors of a hospital treated equally regardless of their economic status, has long been anathema to the Tories particularly those in thrall to the market.

Later on in the nineties a Labour government despite, to its great credit, bringing funding of the health service back into line with that of other western nations, continued the process of marketisation and privatisation with the advent of semi-autonomous Foundation Trusts free to adopt a more business-like approach to managing their finances, an expansion in the use of the Private Finance Initiative to build new hospitals, a huge increase in the use of management consultants and the introduction of a system of financial flows misleadingly labelled as “payment by results”.

That there is a “market” at the heart of the NHS is a point completely lost on the vast majority of patients and members of the public. And that this system is estimated to cost somewhere between £4.5 billion and £30 billion a year to run (to pay for accountants, analysts, contract negotiators, legal advisors, computer software etc) depending on which study you believe, is barely mentioned by any senior NHS figures, politicians or think tanks when discussing how the health service could save money. Remarkable given the near obsession with cutting costs. Having worked in NHS finance departments for over twenty five years I am struggling to think of a single significant benefit that this market system has brought to patient care.

And now along come the new kids on the block, the so-called Sustainability and Transformation Plans or STPs which break the NHS down into 44 regional “footprints” and provide the means by which NHS England hopes to extract a further £22 billion worth of savings by the year 2020. This is on top of the £20 billion already squeezed out of the system in the first half of the decade; a programme of efficiency savings that was referred to as QIPP or Quality, Innovation, Productivity and Prevention and sold us the notion that somehow the dire economic situation following the global financial crisis of 2008 presented the NHS with an “opportunity” to simultaneously strip £20 billion out of its budget and improve the quality of patient care. That the QIPP “challenge” was inflicted on the NHS at the same time as a major reorganisation of services following the Health and Social Care Act simply rubbed our noses in the dirt.

The Sustainability and Transformation Plans are based on work that has been going on across the country for several years now looking at “reconfiguring” health services labouring under such nonsense-names as “fit for the future”, “healthier together”, “shaping a healthier future” and “better services, better value”; words stripped of their true meaning to concoct meaningless slogans fed to a public too busy whipping themselves into a frenzy over cake baking on the telly to be unduly concerned about the potential closure of their local Accident & Emergency department.

Delve into the small print of the plans and they talk of how “difficult decisions lie ahead”, of how local health services in each “footprint” will “look very different following transformation” and, with almost breathtaking arrogance, that this represents “the right thing do” and the only way to ensure financially and clinically sustainable health services. It’s true that local health services will look very different in many areas of the country if these plans come to fruition – but certainly not in good way. It’s likely, for instance, that the number of A&E departments nationally will be “reconfigured” to between 40 and 70 as these plans kick in; there were 140 A&E departments around the country in 2013. So we’re all going to have to get used to longer journeys to receive emergency care in future. For many of us, instead of a relatively short ambulance journey across town this could well mean a twenty or thirty mile trek to the nearest big town or city.

This ideological assault on the NHS has brought us to the current situation where more than eighty per cent of hospitals are in debt and during the last financial year the NHS as a whole was £2.5 billion in deficit. To put that into some sort of perspective, when the Tories came to power in 2010 the health service was breaking even. Ironic that the party that prides itself on “balancing the books” should make such a mess of the finances of the NHS.

It’s perhaps worth pausing at this point to recognise that the dire financial situation that the NHS currently finds itself in is far from accidental or somehow inevitable as the government would prefer us to believe – it is the result of a stark political choice, pure and simple. The government has chosen to starve the NHS of much needed funds with the result that since they came to power in 2010 they have overseen the biggest sustained cut to the amount of money that we spend on health care since the birth of the NHS in 1948. As mentioned earlier, the Labour government of 1997 to 2010 through substantial investment in the NHS brought the amount that we spend on healthcare into line with that of other leading European nations. Six years later however, we now spend 8.5% of our gross domestic product on healthcare, considerably less than the Netherlands and Germany who spend around 11% and also less than the likes of Greece, Portugal and Austria.

This fact alone makes a mockery of the argument that is continually trotted out that the NHS is overspending, that it is inefficient and that if only those bolshie doctors and nurses, instead of protesting and walking out on strike, worked a little bit harder then we would not be in this mess. Far from being the result of inefficiency on the part of its hardworking clinical staff the financial crisis that the NHS currently faces is ultimately the product of a world view that huge multinational banks are too big and too important to fail but the health of the nation is not. That we can justify spending billions on weapons with the capability to wipe out hundreds of thousands of people but refuse to adequately fund our health service is difficult to stomach.

By rights we should be on the streets protesting at this government’s dismantling of our heath service. Far from being unaffordable a fully functioning NHS is absolutely essential to a successful economy. How can we hope to have a booming economy if people are too ill or too frail to work? A point that is often overlooked in the debate on affordability is the fact that for each one pound that we invest in the NHS we receive three pounds worth of benefits to the wider economy.

And where does this notion that the NHS is somehow grossly inefficient come from because it’s simply not borne out by the evidence. A comprehensive report by the independent Commonwealth Fund in 2014, for instance, hailed the NHS as the best healthcare system out of eleven of the world’s wealthiest countries. Switzerland was second and Sweden third with the likes of France, Germany, the Netherlands, Canada, the USA and Australia lagging further behind. The NHS scored highly for the quality of the care it provides, its efficiency and the low cost at the point at which it is used by patients. In terms of overall costs the report found that the UK spent the second lowest amount on healthcare; about £1,990 per person compared to nearly £5,000 per person in the US.

Yes, the NHS has its faults, but let’s face it what other organisation of similar size doesn’t? It’s a vast organisation that sees and treats around one million people every thirty six hours. However, despite the many pressures it faces it is a wonderful system that blends quality, access, efficiency and affordability and it bears comparison with any other healthcare system in the world. In fact, it does more than that, it’s the top of the pile which is a fantastic achievement.

On the other side of the pond, meanwhile, the US health system, frequently held up as a role model for the NHS, demonstrates the failure of applying market principles to healthcare. The US spends around 18% of its gross domestic product on its insurance-based healthcare system yet nearly 50 million people are uninsured, up to 100 million have insufficient insurance to cover their needs and life expectancy and infant mortality lags well behind that of other western countries. The health policy expert Allyson Pollock has described the US system as “islands of excellence in a sea of misery”.

So it comes as no surprise that when we finally get a political leader who challenges this deeply entrenched view that there is no alternative to austerity that, of course, it scares the hell out of other politicians and the press barons and broadcasters who fail to hold the government to account, protect this mainstream view and in the process label anyone who makes the case for an alternative, be they a politician or a striking junior doctor, as some sort of extremist. In the last few weeks, the Labour leader Jeremy Corbyn has promised that a future government under his leadership would scrap the pointless and expensive NHS internal market. This is a potentially huge step that signifies the rejection of more than two decades of the NHS snuggling up to big business; a real “game changer” in management-speak mumbo jumbo. And it takes strong political leadership too a world away from the timidity of the likes of David Cameron and Theresa May too afraid to stand up to the might of huge multinational companies keen to grab a slice of the billions spent annually on the NHS.

The NHS has been around for nearly seventy years, is something that we should be proud of and provides proof that putting people before profit can work. I’m tired of hearing politicians on all sides trot out the same arguments about how the health service must make efficiency savings if it is to survive. And I’m tired of this political gobbledygook being swallowed unquestioningly by those who run the NHS, its chief executives and directors and senior managers in the name of not rocking the boat and preserving their careers. All of us who work in the health service are there because there are times when people suffer ill-health or accidents and need someone to treat and look after them and we should speak out on behalf of these people. At last there is a politician who is prepared to do this and who is prepared to consider a different approach to managing the health service.

So excuse me if I don’t entrust the leadership of the political party that created the NHS to a former lobbyist for the giant pharmaceutical firm Pfizer. Owen Smith? You’ve got to be joking. Instead I’ve voted (for the second time in just over a year) for someone with the balls to actually begin to tackle the problems that face the NHS and actually commit to restoring it as a public service free from the clutches of big business. And the same is true of education, transport, the environment, defence and workers’ rights. What Jeremy Corbyn represents for me is the hope that we can collectively build a better world after a generation and more of neoliberal politics that has tried to convince us that socialism is dead and that subjecting public services to the rigours of the market is the only way forward. I was proud to vote for him last September and even prouder to do so again now.

At various points over the last few weeks a number of people have, with a look of pity usually reserved for a pet who’s curled out a turd on the front room carpet, said something along the lines of “I suppose you’re voting for Corbyn again then are you?” to me. And yes, I have. I did it on the same day that my ballot paper was emailed to me. I couldn’t give a monkey’s about whether he sings the national anthem or how deep he bows in front of the monarch or how he dresses because frankly if you care one iota about the future of the NHS you’d be stark raving bonkers not to vote for him. It feels like, to coin a phrase, “the right thing to do”.


From → NHS, Politics

  1. Thanks very much for sharing it Cath

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